Hagith Nagar

Risk Factors, Symptoms, and Treatment of Ovarian Torsion in Children: The Twelve-Year Experience of One Center

OBJECTIVE To assess risk factors, clinical findings and mode of diagnosis and treatment in premenarchal children with surgically verified ovarian torsion (OT). STUDY DESIGN A retrospective case review (Canadian Task Force Classification II-2). SETTING Teaching and research hospital, a tertiary center. PATIENTS Premenarchal children with surgically verified OT. INTERVENTIONS Patients underwent either laparoscopy or laparotomy. RESULTS Twenty-two cases of OT in 20 premenarchal girls (median age 12 years) were identified. Three cases involved recurrent torsion after detorsion without cystectomy. The main presenting symptoms were sudden pain and vomiting. Six patients underwent Doppler examinations, and all demonstrated an abnormal flow. Seventeen interventions were by laparoscopy. Conservative management, mainly detorsion with additional cyst drainage or cystectomy, was performed in 19 cases (86.4%). Oophoropexy was performed in 3 cases (13.6%). Pathologic examination demonstrated 5 simple cysts and 1 dermoid cyst. CONCLUSIONS Ovarian torsion in premenarchal girls usually presents with intermittent abdominal pain and abdominal tenderness. Other signs and symptoms are nonspecific. When performed, Doppler imaging may assist in diagnosing ovarian torsion in children. Detorsion followed by cystectomy may prevent recurrence.

Umbilical granuloma: a new approach to an old problem

Abstract. Umbilical granuloma (UG) is the most common umbilical abnormality in neonates, causing inflammation and drainage. Most fail to epithelialize and persist for more than 2 months. The common treatment is application of a 75% silver nitrate stick, usually repeated two to three times over a number of clinic visits. Burns have been reported following spillage onto the surrounding tissues. During a 10-year period, 302 neonates were treated for UG using excision and application of absorbable hemostatic materials. Healing was uneventful in all cases, and no complications have been encountered to date. This technique is simple, safe, and inexpensive, and obviates the need for repeated outpatient visits.

Stitch granulomas following inguinal herniotomy: A 10-year review

During the years 1982 through 1991, stitch granulomata complicated 15 of 2,447 inguinal herniotomies. The lesions were diagnosed 3 to 120 months (mean +/- SE, 2.46 +/- 0.65 years) following surgery. Granulomata were associated with male sex (P = .02), emergency herniotomy (P = 0.016), surgery during the neonatal period (P = 0.004), and lower mean age at the time of herniotomy (0.79 v 2.84 years, P = .000001). In 13 cases, Staphylococcus aureus was recovered either alone or in combination with Staphylococcus epidermidis; all patients responded well to incision and drainage. Stitch granuloma appears to be associated with male herniotomy, emergency surgery, and use of silk sutures.

Decision-making in pediatric varicocele surgery : use of color Doppler ultrasound

Abstract Although varicoceles are common in adolescence, the indications for surgery as well as the procedure of choice are controversial. We have evaluated the use of color Doppler ultrasound (CDUS) as an objective tool in the assessment of such patients in a 5-year prospective study for determination of varicocele size, venous flow patterns, testicular volume, and resistance index. A high ligation was performed only when reverse blood flow was demonstrable in the varicocele during a Valsalva maneuver, and a low approach when this finding was absent. Twenty-six boys underwent low ligation and 53 high ligation based on the findings of CDUS. The incidence of recurrence (3.8%) was lower than that encountered by the same surgical team prior to introduction of CDUS (20.5%) (P = 0.004). These results are even more striking when contrasted with published recurrence rates of 12% to 15% (P = 0.015 to 0.003). Thus, CDUS proved to be a useful tool in selecting the proper surgical approach for varicocele in adolescence. The incidence of recurrence was significantly reduced following the introduction of this procedure.

Congenital sublingual teratoid cyst. Case report

A sublingual teratoid cyst was excised without complication from a 4-month-old infant. Teratoid cysts of the mouth are rare, and generally diagnosed in adults. The differential diagnosis and approach to sublingual lesions in the infant are reviewed.

Triple Gallbladder Preoperative Sonographic Diagnosis

Triplication of the gallbladder (GB) (vesica fellea triplex) is a rare congenital Tanomaly of the biliary tract not likely to be revealed unless there are associated symptoms. To our knowledge, only 10 cases have been reported in the literature. 1 - 1 0 The first reported case was described in a human cadaver in 1752. 1 In the most recent case, reported in 2003, triple GB was diagnosed during laparoscopy, whereas preoperative sonography failed to show the abnormality. 2 We present a case of this rare anomaly diagnosed preoperatively by sonography and endoscopic sonography confirmed on laparoscopic cholecystectomy.

Surgical aspects of parasitic disease in childhood

This is a review article concerning the surgical aspects of parasitic disease in childhood. The surgeon encounters parasitic disease for a variety of reasons. Many forms of infestation produce or mimic anatomic diseases of the gastrointestinal tract. Others are characterized by soft tissue or visceral mass lesions, lymphadenopathy, portal hypertension, etc. The surgical aspects of parasitism extend to all subspecialties, including ophthalmology, gynecology, and plastic surgery.

Bacterial orchitis in a baby with imperforate anus

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Crossed testicular ectopia

Crossed testicular ectopia is characterized by the presence of both testes in one hemiscrotum. A 7-month-old boy with this condition is described and the relevant literature reviewed. Although this anomaly has been recognized for over 100 years, its etiology is not yet established. The advent of ultrasonography has allowed early diagnosis and therapy in recent years.